Woman's Hour - Endometriosis pill, Bollywood star Radhika Apte, Ramadan health

Episode Date: March 13, 2025

The first daily pill for treating endometriosis symptoms has been approved for use on the NHS in England - but only for patients who have tried all other options. Endometriosis affects 1.5 million women in the UK. Kylie Pentelow is joined by Emma Cox, Chief Executive of Endometriosis UK, and Emma Collier, who was diagnosed with endometriosis aged 18, to discuss what this could mean for women.Sister Midnight is a new, Bafta-nominated, Hindi-language film that looks at what it's like to be a misfit. This dark comedy follows an oddball couple thrown into a newly arranged marriage in a small Mumbai shack. Indian actor and Bollywood star, Radhika Apte plays Uma, one half of the couple, who does her best to cope with her new role as a housewife in the heat of Mumbai. Radhika joins Kylie in the Woman's Hour studio.The holy month of Ramadan is underway, which means millions of Muslims around the world are fasting, no food or drink from dawn until dusk - not even water. At the end of each day, friends and families celebrate the breaking of the fast with a meal together. But for those with current, or past eating disorders, this period of fasting can bring challenges. So, how can they be best supported during Ramadan? Kylie talks to fitness trainer Nazia Khatun, who has struggled with anorexia and bulimia in the past, and counselling psychologist, Dr Omara Naseem, who specialises in eating disorders.Journalist and broadcaster Julia Raeside has just published her debut novel, Don't Make Me Laugh. Looking at the world of stand-up comedy often dominated by men - it's described as celebrating women who speak truth to power, find solidarity with each other and then decide to fight back. Julia explains to Kylie why she chose to focus on the world of comedy for her first foray into fiction.Presenter: Kylie Pentelow Producer: Melanie Abbott

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petruzzella, and from the BBC, this is Extreme. Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2. And of the risks it will take to feel truly alive.

If I tell all the details, you won't believe it anymore. Extreme peak danger. Listen wherever you get your podcasts. Hello, this is Kylie Pentelow and you're listening to the Woman's Hour podcast. Hello and welcome to the programme. Coming up today, we are in the month of Ramadan where Muslims don't eat or drink during the hours of daylight. But what impact does that have for those who have eating disorders? We'll be speaking to an award-winning fitness trainer who's struggled with anorexia and bulimia in the past about how she

navigates Ramadan. Also, if you're a fan of Bollywood films, you will undoubtedly know the name Radhika Apte. She is a huge star with a massive following. She made waves in her roles in two hit Netflix series and is back with a new BAFTA-nom. In the film she plays a woman who's just got married and is somewhat clueless. She has to, shall we say, wing it when it comes to household tasks like cooking. So I'd love to hear from you on this. Have you been in a situation where you had to hide not knowing how to do something because everyone assumed that you could? If I can give you an example from personal experience here, I concealed that I couldn't ride a bike for years because while I was ashamed of it, I avoided any situation where riding a bike might be involved. Eventually I did learn, but for a long time it was something everyone just seemed to assume that I could do.

So we want to hear from you on this. You can text the programme, the number is 84844. On social media we're at BBC Woman's Hour and you can email us through the website. You can send a WhatsApp message or voice note too using the number 03700 100 444. I'm looking forward to hearing all of your stories on this. Also joining me in the studio, journalist and writer Julia Reyside to talk about her first novel which is set in the world of stand-up comedy, a sphere that is often dominated by men, which looks at control, misogyny and the dark side of making people laugh. But first, the first ever daily pill for treating endometriosis symptoms has been approved for

use on the NHS in England, but only for patients who've tried all other options. Endometriosis affects 1.5 million women in the UK, causing pain and extreme tiredness as a result of tissue similar to the womb lining growing elsewhere in the body. The new tablet has been approved by the Drug Assessment Body, the National Institute for Health and Care Excellence, NICE, and unlike current injectable treatments, it can be taken at home. Well, to discuss this further, I'm joined by Emma Cox, Chief Executive of Endometriosis UK, and Emma Collier, who was diagnosed with endometriosis at the age of 18, to discuss what all this could mean for women. Emma Cox from Endometriosis UK, if I can start with you, how much of a game-changer could this pill be? Well I think it's going to be a game-changer for

a small number of people. So NICE themselves are saying that this is a treatment that they've licensed for people where certain other treatments haven't worked and they estimate it will affect about a thousand women and for them I think it'll be really positive. But it is a drug that basically mimics menopause so it puts women into menopause and that isn't a treatment for lots and lots of people and I think that so I think that it's a real positive step but not for the majority of people with endometriosis yet. So it could in effect have other implications of the side effects then from putting you in the menopause?

Well the idea with the new drug is that it has less side effects than the current drugs that do. So currently if you're going to be put into menopause you'll generally have an injection, an implant and that will then last for four to twelve weeks. But if those symptoms, if you end up with significant symptoms because you know your body isn't expecting to go into menopause or you don't like the drugs then obviously you're stuck with that. Whereas this drug is a daily tablet so firstly it can be taken at home by yourself, you don't have to go into hospital every now and then and also it's got included HRT ad-back so it protects from some of the dangers there are around

bone issues and heart issues and it's included so you don't have to take it separately. And of course should there be symptoms that you don't like then you can stop taking it. And what we find from talking to those with the disease is for some people they find that the drugs that put them into menopause are really really helpful, they manage their symptoms, they find that the drugs that put them into menopause are really, really helpful. They manage their symptoms. They can get about their day-to-day life. Whereas for others, they don't work in terms of the other symptoms they get are quite harder as well.

So it's one of those drugs that helps. But it is interesting. They've licensed it only where people have tried something already like this, but it doesn't work. And I do wonder why we can't just try on people straight off if they're going into that but as I say I think it'd be really positive for a small number of people. Yeah that is an interesting point that you know it is only available for patients who've tried all other options so potentially they could have gone through what surgery

and various other injectables to get to this point? They could and not everybody will be with endometriosis will ever need to take a drug like this that puts them into menopause and as we know some with endometriosis have mild symptoms where others they're very debilitating and it can vary through their life and so I think that it does feel like at the moment that as I understand it that people will have had to try the other drugs not necessarily surgery to go through with this. And I do think there's a really question I have is that one of the challenges we have at the moment with endometriosis treatment

is the waiting times are shockingly long for gynaecology. The waiting times went up by the highest percentage in gynaecology over COVID, they've stayed high. I won't rant about that too much. But for some people, sometimes are recommended to take the drugs, the drug group of drugs that put you into menopause while waiting for surgery so that the disease doesn't progress. And should that be the case, I would wonder why somebody couldn't take this new, supposedly better drug, rather than having to try one of the more traditional ones. Emma Collier, if I can come to you, we were saying you were diagnosed with endometriosis at the age of 18, you're now 31. Can you just describe to us the impact it's had on your life?

Yeah, hi Kylie, thank you for having me on. I was diagnosed at 18, it was seven years until I had an operation. So I was 25 when I had my operation. And I was seeing gynaecologists constantly trying to get some treatment. I kind of tried everything. And the impact was completely debilitating. So just to put you into context of where I am now, I'm now 31. I have been on the coil and I've just been told I need to have another surgery. So the impact for me, the biggest impact was pain. I've written about this before, but it's such incredible pain.

It's quite hard to describe, but I would be sick from pain. I would pass out from pain. This is pain with periods. And it's completely debilitating. It's the most unbelievable pain. It feels like you're being stabbed. And when you know what's actually going on in the body,

it's not just painful period. I had the endometriosis on my organs. You have organs that are bleeding and tearing. And it's very horrific and basic pain. And the kind of hardest thing as well is the emotional impact. You go through this, it's kind of very traumatizing to go through that experience, then you know

you're about to go through it again in another three weeks. And I'm a very sociable person, I'm a very hardworking person, I love my job. And having to try and predict your life around when your period is going to come. I remember when my brother was getting married, I was absolutely dreading that it might land on the day of my period.

And if there was a big, big event at work, you have to try and manage everything around it. And the impact is huge. But also knowing that there's no treatment available for you and continually trying different things and them not working, you've really, really reached some very low points you feel completely helpless.

And I've had two really good periods, really two really good years on the coil and have then been now told that I have to have another surgery because it's grown back. I was hospitalised twice at the end of last year with severe pain again. So it's just this constant, you know, you might have a small grace period and then it kind of hits you again. It's quite devastating being told that it's

grown back and yeah, the impact is just huge. I can't overstate it. I'm so sorry to hear what you're going through. When you heard the news then that this new pill is available on the NHS, what did you think? I've got to be honest, I wasn't celebrating. I think, you know, from my experience of how poor the treatment has been and I'm talking about, you know, at the very beginning of this, I was obviously 18 when I was diagnosed, I used to have cases where I'd go into A&E. My mum came into A&E with me one time and we had to explain to the people there what endometriosis was, the medical

professionals. And, you know, that's what I've kind of dealt with. And I've gone through, you know, I've done kind of hormone therapy. I've done the pill. I've done the thing where you rub the progesterone into your arm. I've done everything and the treatment has been really poor. So I just don't trust it. I think also the key is, as Emma Cox said, it will only help a relatively small number of people.

So I think any step forward for me is a good one, but I'm not celebrating. I don't think this is, you know, I think so much more needs to be done. And I'd be reluctant to take it, if I'm honest. I think, you know, anything that affects your hormones has its own side effects. And that's, you know, that's the honest truth of how I feel. We have had a statement from NICE who they've approved the pill, as we said. They said to us, it's an important new option and offers hope

for women who have tried other treatments without finding adequate relief. Unlike current treatments that need injections at a clinic every few months, this new pill can be taken at home. Doesn't make your symptoms worse when you first start it, which injections offer do and if you stop taking it, your body returns to normal more quickly. This is especially helpful for women who might want to get pregnant after treatment. Just coming to you again Emma Collier, you were talking about the fact that you've had to go in and out of hospital. I guess one positive here is that this can be something that you take at home. Yeah, I think that is a positive. I mean, you know, going into hospital, going to see gynaecologists, it's such an upheaval and it's like an extra job

on top of your own job, you know, and the treatments are quite invasive. So I think, I guess that is positive that you have to take it at home, but I think, you know, if any side effects come with that, that's just as invasive, you know, it's balancing the two, isn't it? Emma Cox from Endometriosis UK, we said that this is only available in England, so what about people in the rest of the UK? It's available in Scotland as well, but we're still waiting to hear, I presume that Wales will follow suit pretty quickly and we'll have to be pushing in Northern Ireland. I think though that this needs to be part of a bigger push

to support all those with endometriosis. And as Emma Collier has said, there are very limited treatment options other than surgery and hormonal tablets. And for some, those are not appropriate. And I think also that endometriosis is a bit complex in terms of it impacts different people differently.

So I recognize Emma's journey. Sorry that you've experienced that, Emma. That is something that a lot of people do experience. For others, they'll have one surgery and that will be all that they need. Or for others, they can be managed with hormones. And I think we need to basically gear up the scientific community to start doing more research

and the government should be investing in more research. So Emma, Collier and others can get some treatment options there. There's been historically such a lack of research money gone into women's health and the pittance of that gone into endometriosis and so we've really got a lot to make up for to try and find people the support they need. We should just point out, presumably you'd say that if anyone is you know listening to this concerned about symptoms that the first port of call is their GP? Absolutely and we know, and Emma described it as

well, and we know that there can be quite a delay in diagnosis. The average in the UK is a shocking nine years at the moment, that actually went up over Covid. So if you have, might have symptoms, and what we say is that whilst periods may be painful, if they're interfering with your day-to-day life there could be an underlying medical problem like endometriosis so please do go to a doctor. But my top tips would be ring up your GP practice and ask if they have a GP that specialises in women's health and you're more likely to have someone who knows about this. And also keep a pain and symptom diary so you can explain what

you've been feeling because I think quite often people that might have different symptoms, so for example you can have bowel symptoms possibly on ovulation, you might have other times of the month etc and it can be quite hard as an individual to know how to piece those together. So yeah I think to aid a diagnosis do that and we are as many others are pushing for improved education of healthcare practitioners so the symptoms are recognised and taken seriously. And that's an issue and I'm thinking Emma's colleagues probably experienced this, is just not being believed about periods, being told it's normal, being told you're being a bit of a wuss, you should man up, always a lovely statement. And actually

all the time that impacts on your mental health because you think well I'm in real pain and yet I'm being told it's in my head. So there's a whole package of things we want me to do around that. But if you do think you have symptoms, please do go and ask a GP. Emma Collier, just a final word from you. Do you think things are improving and there is more understanding as we talk about endometriosis more? I definitely think awareness is improving. I have noticed that. I mean, I went through years of, again, as I've said, having to explain to people what it is, tell people what it is. And I think the biggest shift is that, as Emma Cox has just said, I would have doctors,

both male and female actually, kind of making me feel like I was complaining about nothing really. And it's really, really serious. That's what I'm trying to get across is the symptoms of endometriosis are very serious and I think people are understanding that more. I just notice it more being spoken about and being recognised and being understood but I'm going to echo what Emma Cox says as well. There needs to be more research, there needs to be more done and more support. And I think anyone listening to this who has endometriosis, I just want to say, you know, one thing it's given me is a hell of a lot of resilience. And, you know, I have people in my life, you know, telling me that they think it's amazing that you deal with this and how resilient

you are. That there's, you know, everyone who has it, they're incredibly strong people. If you feel like you're not and you feel like you go to a GP and you're made to feel kind of weak or pathetic, you're unbelievably strong. So that's the point I want to get across. Thank you so much. Emma Collier and Emma Cox from Endometriosis UK, thank you so much for your time here on Women's Hour. Now, is the feeling of being a misfit something you've felt in your life? You might feel like you don't have everything together or you aren't able to catch on to those everyday things as easily as your counterparts. When you BAFTA nominated Hindi language film Sister Midnight looks at just that, the dark comedy follows an oddball couple thrown into a newly

arranged marriage in a small Mumbai shack. Indian actor and Bollywood star Radhika Apte, who you might know from her roles in Netflix series like Sacred Games and Ghoul, plays Uma, one half of the couple, who does her best to cope with her new role as a housewife, tackling things like budgeting, nosy neighbours, making dinner and the heat of Mumbai. And I'm delighted to say that Radhika is with me in the studio to discuss this. Thanks so much for coming in. Hi, thanks so much for having me. It's an interesting film isn't it? Your character Uma is a very very different kind of that to that stereotype of leading ladies I would say. She isn't afraid of what other people think. Is that what drew you

to the role? Yeah, I mean, she's a real oddball. The funny thing is though, what drew me to the role also was that I've met women like her a lot more in real life. I mean, if you go to a Mumbai slum, you'll meet women who have foul mouths and who will scream at you and who will get the job done the way they want it to get done. And I think people need to show these women on screen and women are not necessarily the way we see them on screen at all. So I think I was like, oh, I know these women. I know Uma from so many women I've met in my life. We see her struggle, as I was saying, with the sort of everyday expectations that there

might be, rightly or wrongly, of a housewife. Did you relate to that at all, being a misfit, being an outsider? Yes, being a misfit for sure, being difficult and being a misfit because growing up in a city called Pune, which used to be sort of a small town, now it's a big metropolitan city. But although it was culturally very advanced and it's a very progressive place, there were still expectations and a teenager and then a woman in her 20s constantly asking questions was a problem. It still is sometimes, isn't it? Well, let's talk about you speaking up. You've previously said that you've been typecast in more serious roles. Maybe that could be to do with the fact that you've been typecast in more serious roles.

Yeah. Maybe that could be to do with the fact that you're happy to speak out. Yes, absolutely. Tell me more about how that connects. I don't actually know. I was quite surprised myself. I live in both countries, India and the UK. Now I predominantly live in London, but a while ago I met this very big Bollywood producer, director, and after being in the industry for a long time,

you know, when I finally met him, he said, oh, I had such a great time chatting with you, you're so much fun. I mean, I was like, oh, okay, am I supposed to feel flattered? I don't know. But why did you think I was not fun? And he was like, because you're always so opinionated and you constantly like speak out. And I literally wanted to punch him in the face. I mean, not literally, but I was like, am I supposed to feel happy about this? I don't know what you're saying. But then I realized that I was perceived as a very serious person, because I say what I feel like, I just did.

And that just means I'm cantankerous or I'm difficult or I don't know what. And so I couldn't get any light comedy or romantic roles for that matter. What made you want to talk out? You've called out misogynist behaviour before. Yes I have. Where is that drive? I don't know. I mean I was working in a particular film industry and my general experience in that industry was that, I mean, there's so many wonderful men and women in that industry as

well, of course, but my particular experience was very unpleasant. And I spoke against it and I called out and I got a very bad, I mean, I got backlash and they told me I would never work in the industry again, which did not happen. I did actually get even a bigger film offered. So of course the industry, there are people who are very, very progressive, but I think it comes from my upbringing predominantly. My parents are very progressive.

My family is very progressive. I've met a very progressive man in my life, Lucky, and his family is also extraordinarily progressive and feminist. But also my school. My school was a few parents came together and decided at that time that they didn't want to send their kids to the conventional school. And they started a school in a small lodge and I was in the first batch of the school. And so it was all about asking why and actually talking about what you think and what you feel and openly exploring your thought process and changing with time as well, not being afraid of changing your own opinions about things because they do change. I might believe in a certain

thing today, two years later I might not believe in it and to even be open to that and I thought I really think that I was very lucky to have gone to that school. I heard you talk about being involved in a production where you were noticing certain behaviors that you didn't like and you didn't speak up and you felt terrible about it. I did. Can you tell me about that? Yeah. So there was a, yeah, it's, and it's not happened once, it's happened a few times.

You know, I have to say, I do consider myself very progressive, but there's so much more I need to learn Because I think that the biggest challenge is to be aware yourself of what? Your own rights and and what is okay and what is not okay because we've lived in a world where Where it's it's it goes so much deep It goes so deep inside us that we sometimes don't know that something happening to us is not okay but it feels uneasy, right? And I think it takes a while to actually trust your instinct and what I've learned over the last many years of working in the just being a woman is that the one thing I

didn't do is learn to listen to my instinct. And I still sometimes I'm afraid because I feel what if I'm wrong? Am I really reading this correctly? And so I didn't speak against it for a long time and I had to go to my therapist and I say, can I please take a quick session? I said, what's happening? And I said, I don't know. I come home and I eat everything there is in the fridge, like literally everything there is in the fridge. And I don't know why I'm doing this.

And he said, you know, the motion of swallowing is to basically swallow your feelings and you're so angry and you're just trying to put it down, just go tomorrow at work and tell them what you think calmly. And I did it and I stopped eating everything in my fridge and then I could do something about it but for a long time I didn't and there have been many times where I've not spoken out. It is hard though isn't it? You know I'm sure that many of our listeners will have been in those situations where they've been afraid to speak out because they might lose their role or they think something might happen to them.

Do you feel though a bit more of a responsibility? You have a huge following, you're very successful. Do you feel that responsibility that you need to speak out to represent others? I do and I think I feel an even bigger responsibility to myself because I really genuinely can't sleep at night when I don't speak out. And it had to, I had to reach a point where I had to say to myself, you know what, if it doesn't work out, it doesn't work out. If I don't continue to act, it's fine. And only when I actually reach there psychologically, not just saying it, just actually reach there, and I started caring less, I spoke out more. And one shouldn't be in this situation. One

should absolutely not be in this situation, but we are in that situation. And to my surprise, actually work still came and actually work. And to my surprise, actually, work still came and actually work, and now I've realized I want to work with people who respect me. And so I'd rather do that anyway. And so you realize that, oh, those things that I was chasing, I didn't really want them. So that's quite liberating.

I think there's this, I mean, I did a play a long time ago and it was based on Rumi's, the poet, his poems. And there's this poem when this woman is standing by the bank of a river and she says it's a stormy night and she says there's a boat on the other side of the river and how do I get to the boat? And the fakir in the poem says to her that just jump. And she says, okay, and I just jumped and I was swimming towards the boat and the boat came towards me and we met each other midway. And I think that's what happens when you actually take

that jump and you say, no, I'm just going to do it. And yeah, I think that's what happened. I love that. In the film Sister Midnight, there were quite a few references to skin whitening throughout the film. Can you tell me a bit about that? Is that something that you're concerned about? Oh, no. I mean, of course I'm not. I used to be when I was a teenager because, I mean, to be fair, if you see the women actors in Bollywood today, there are dusky women now, but there's no one with really dark skin. And India is full of women with really dark skin. So you still don't have that. And at least dusky women are now suddenly very beautiful in the last whatever decade or so. But when I was younger, I was a child, they were quite

fair. When I started in the film industry, they used to do three layers of makeup on me, right? First you do orange to sort of take the color a little brighter or something. I might be wrong. The makeup artist listening to this, please don't hold me to it, but they did make me fairer. And I remember bleaching your facial hair was a big thing back then. So I did sort of fall into that in the beginning and I used to bleach my face, skin,

and the hair would go golden, but my skin would remain the same and then I just thought that I'm done with this and I stopped waxing and threading and bleaching anything. But so now I of course I absolutely I'm very proud of my colour but I do think we don't have representation and it is essential that we do. I just thought in the film there was a point where she was asked about the what products, your character Rima was asked about the products that she uses. And actually it was a time when she was incredibly unwell.

And I just it was just really poignant to me. So it's important for you then to explore that. Yes. Yes. Yes, yes, yes, absolutely. I think, and it's, I love how that current actually has made that point in the film and it's so, in her most vulnerable state, somebody comes and does that to you and she just looks at the woman horrified. You are great in it, I have to say. just should mention we asked the producers Guild of India for a response But we haven't heard back on some of these issues You mentioned that you share your time between England and India. I wonder what it's like for you

in terms of fame and being recognized in the two countries I hate it I hate it. You hate being recognised or you hate the anonymity? No, I hate being recognised. If my friends say you're in the wrong profession. But I literally, and I come across as a very rude person, if you recognise me on the street. But I'm actually not rude. I mean, the intention is not to be rude.

The intention, I just, something happens. I just shrink. Because I feel I'm in my private life and I don't like to be looked at. I don't wear makeup or I don't, I hate wearing makeup. As you can see I'm not wearing makeup right now either. And I just don't like to be dolled up and I don't like to be looked at when I'm not working. And I think I love India. I absolutely adore India. And I'm always an Indian in my heart, but we don't have boundaries in India. You know, people come and they grab you

and they think that they know you and they want to take selfies. And I'm sorry, I'm very old school. I can't do selfies. I can't do it. And so forgive me but I'm just, I'm going to be like this. I don't like it. So just finally, I just want to say you've had a baby recently. Yes, I did. Congratulations. Thank you.

You've also shared a bit of the reality of a baby. You shared a picture at the BAFTAs where you were breastfeeding with a glass of champagne in your hand. I love that. Yeah, I got trolled for that. Oh, I bet. What's it like now having a very little one and still working and doing everything as well as being a mum?

I am so tired. I'm absolutely knackered the whole time. But I have to say I'm working with a bunch of great people who are constantly supportive. But you know, I was trying to work and I'm trying to have a, like trying to be there for my child. I'm trying to be there for myself, you know, for my exercise, for my little bit of sleep that I sometimes get. And all, I'm meeting friends, but a friend of mine I was talking to and she said, the thing is, why do women have to prove themselves by going to work immediately either, right? And I was like, my God, you've made such a great point, because that's also true. I mean, when people say that, oh my God, you're working right away, that's great.

It's not great either. It's actually not a great situation, because I'd rather take maternity leave. I initially thought when I, before having a child, I don't'd rather take maternity leave. I initially thought when I before having a child, I don't want to take maternity leave because I love my work so much that I want to keep doing it. But then I had a child and I realized that it's so hard that I really want to go for a coffee with other mothers. You know, I don't want to work. But then the problem is if you don't work, I'm a freelance artist, the certain projects I know will be, not be prioritized,

and it's a really difficult situation to be in. So I'm struggling. As much as I love my work, I wish there was a way to sort of not constantly worry and feel insecure that I was gonna lose that part but it's also I think it's it's it's also something that I need to learn to let go but it's hard and it's also really amazing to be a mother I never thought I'd say this but absolutely love it I never wanted children and then we had a

child and I I feel very happy really happy. So lovely to hear. It's been wonderful talking to you. Radhika Apte, thank you so much for coming in. And just to say that Sister Midnight is in UK cinemas from tomorrow, Friday the 14th of March. Now, I just want to tell you about Monday's programme because we'll be discussing the impact of the Covid lockdowns on babies born during that first lockdown in March 2020. Those babies are now primary school age, they may be in reception class or P1 as it's called in Scotland, but how are they getting on and how has Covid affected them? Well if you're the mum of a

lockdown baby and you'd like to join the live program to share what you've noticed about your child's progress, it may be something to do with speech or language maybe, social skills or mental health or something else entirely, please email us with your experience and contact details. Hello, I'm Robin Ince. And I'm Brian Cox and we would like to tell you about the new series of The Infinite Monkey Cage. We're going to have a planet off. Jupiter versus Saturn. series of the Infinite Monkey Cage. We're gonna have a planet off. Jupiter vs. Saturn! It was very well done that because in the script it does say wrestling voice.

After all of that it's gonna kind of chill out a bit and talk about ice. And also in this series we're discussing history of music, recording with Brian Eno and looking at nature's shapes. So listen wherever you get your podcasts. Now the holy month of Ramadan is underway, which means millions of Muslims around the world are fasting. They don't eat or drink from dawn until dusk, not even water. At the end of each day, friends and families celebrate the breaking of fast with a meal together. But for those with current or past

eating disorders, this period of fasting can bring challenges. So how can they be best supported during Ramadan? Well, joining me in the studio to discuss this is Nazia Khatun. She's an award-winning fitness trainer who struggled with anorexia and bulimia in the past and also counselling psychologist Dr. Amara Naseem who specialises in eating disorders and she's also written a guide to assist those with an eating disorder who are observing Ramadan. Thank you to both of you for coming in today. Thank you. Nazia, can I start with you? You're very open about your struggles with past eating disorders and low self-esteem. So when did you notice that you had an eating

disorder or that something maybe wasn't quite right for you? It started with a very innocent run in the park actually. I just wanted to get fit. After school there was no places for females to actually go and participate in sports. And then I went to college and I came from an only girls school then went into a mixed college. So everybody, I mean, the hormones are kicking in, we want to be liked and everything. And what started out as a fitness thing very quickly developed into just starving myself, restricting my calories and being obsessive. And within a very short time, I dropped significant weight. And I think I went from probably about 75 to below 60,

then I went into like my 50s categories and everything. And I knew I had issues because I was just severely obsessed with the way I looked, with any amount of weight that I gained within a night or I was obsessed with the scales and everything. My family knew I had an issue, but because it wasn't a topic that we really spoke about or heard about, it just got brushed under the carpet and I struggled with it for a very, very long time. I didn't realise it was an eating disorder until probably about my 30s or something. I'm now 41. I've only just healed the eating disorder part of my life in the last three years. And it, I would say it robbed me of my 20s. And when I look back at it, I feel very sad,

like thinking, oh my God, I have continuously harmed myself, punished myself with grilling workouts, with starving myself, having headaches, being moody. I was a horrible person in my 20s because the hunger, the hormones, the mood swings, the regulations of my emotions and everything. So it was like an ongoing thing for me to be honest with you. I should just say if you're affected by anything that we are talking about here, there's links to support on the BBC Action Line website. Nazia, what impacted having... How, I guess I'm asking, how was, how did you cope with Ramadan during that time when you were experiencing that terrible condition?

In my 20s, it didn't really affect me so much, I'll be honest with you. It's only I spent amateur boxer in my 20s and where I was addicted to the gym, I used to train all the time and it was another way of me losing weight. It's only when I hit depression at the age of 30 when I changed career and again I'm from a Bangladeshi community we don't encourage females to be boxing, participate in sports, learn on becoming a fitness coach. And it was something that I battled with quite severely. And I didn't realize that depression came from all the unresolved issues I had in the past.

And the eating disorder part of my life popped up. And because it was a traumatic event, I didn't realize how traumatic it was. I slipped into depression quite quickly. And it's only after that period of my life, Ramadan became very, very hard. When we understand the brain, the trauma brain, the amygdala part where it processes fear, then you have the hippocampus memory, then you have the prefrontal cortex, that's the logical part of the brain, but it also uses up a lot of energy and glucose and fuel. So when you are fasting during a time when your brain is always trying to keep you safe

and keeping you in survival mode, it was very, very testing. And it was more testing because one you're questioning your religion and your faith, and then you can't tell anybody because it's guilt and shame. And I think most of my 30s I was just trying to heal that part until I did that actual healing work. And every year is very testing for me. And like this year I managed to do 13, we're on the 13th fast right now and I haven't had any triggers.

So I'm just so proud of myself just getting this far. Yeah, absolutely. Dr. Amara, you're listening to what Nazia is saying. You're a counselling psychologist. You've worked with Maudley's Eating Disorder Outpatient Team. You're a practicing Muslim yourself too. What advice do you give to people with current or past eating disorders during Ramadan? I think it's, I'll give advice for people first of all to say that if you are suffering with an eating

disorder and it's going to be harmful for you to fast, you're exempt even in thinking about our spiritual practice and the laws of the Muslim faith and Islam. If you are healthy, you're supposed to fast. So if you're suffering with any kind of difficulty, mental health is included, which is not always talked about in the community, but physical ailment, disease, illness, so you're exempt. Please go and get help first. Right? First protocol is get help, get healthy so you're exempt. Please go and get help first, right? First protocol is get help, get healthy so you can fast. If you decide to fast whilst

having disordered eating or an eating disorder, one is diagnosable and the other is basically just abnormal, unhealthy eating patterns which will eventually lead to an eating disorder, I would say make sure that you talk to someone and let someone know what you're doing. Get support. You absolutely have to make sure you wake up for sahur, which is the early morning meal. So do not skip that at all. And then make sure you're having like a balanced nourishing meal as well. So complex carbs.

A good example would be something like overnight oats soaked in milk with healthy fats included nuts and nut butters and things or an omelette with some toast and so don't skip have your sahur and then make sure for your iftar meal which is when the meal we have when we're breaking our fast in the evening I would say maybe do this in sections like have a starter so have your water have your dates to break your fast and then maybe like some yogurt and fruit or maybe a soup. Have a break so we're not feeling overly full too quick. Maybe go away and pray, come back and then have your main meal and again make sure this is balanced and nourishing because what we don't want is someone to feel like too full too quick and if that does happen

and it happens to people without eating disorders as well that's okay. Again this is what your support person is for right and you could plan to go for a walk afterwards or get involved in whatever the family's doing or tidy up your dishes but having something planned for after eating as well is important to help you through that little wobble that you might have right with feeling full. It's just a feeling it will come and go and it's perfectly normal and healthy to have it. I just want to go back to something that you mentioned about eating disorders and the fact that there may be many many people who wouldn't tell anyone that they have an eating disorder,

that they're keeping it a secret and then they wouldn't be able to share that and then be exempt. So how do you get across that? Because for some people it's just not something they would want to talk to their family about or explain. Yeah, it's a really tricky one. I would say as well, go to your GP and ask for help. If not, even speaking to a friend, like maybe it's someone out with the community or not within your family, people aren't going to judge community or not within your family. People aren't going to judge you or think bad of you. Everyone has difficulties in life and problems with eating are real.

It's not just something that's in your head. They get worse if you leave them untreated. So what we know statistically is someone's got an untreated difficulty with eating or eating disorder. If you leave it alone, it's going to get worse. So the key is to get in there early and get them help and treatment. So speak to anyone you trust, whether it's a friend, whether it's a teacher at school, someone at uni, it might be more comfortable talking to someone not in the

family unit for example. Or I'm happy for people to even reach out to me and get signposted places, right? Like a culturally aware practitioner who understands the difficulty as well. People within your community, your mosque, your Imam. Some are really well informed about mental health, some not so much, but there are people out there happy and willing to help. So yeah. Nazia, did you feel that, did you feel any issues with kind of guilt for not, for not fasting? Every single year, every single day of the month and it was embarrassing actually because I used to watch my

90 year old grandma fast when we used to break our if that was at 9 o'clock in the summer and it used to always make me feel like a horrible person, like I wasn't good enough and I think that was the core of it, I never felt good enough in anything growing up and the eating disorder was like a control and having speaking about now I openly speak about it because it's awareness for the South Asian community and the programs I developed was I was my first client there's more Nazis out there we need to bring about these conversations so people become knowledgeable and they're able to have

these conversations with their young daughters because the young daughters are now coming to therapy and they need it and I didn't have access to therapy to speak about this because I didn't even know it was labeled as an eating disorder. It's only when I went to a fitness coach in my 30s and her name, the studio was called Dax Mois and it was neuroscience and fitness and the lady who asked me to write down my eating habits and then she asked me what her name, the studio was called Dax Mois and it was neuroscience and fitness and the lady who asked me to write down my eating habits. And then she asked me what is going on here, looking at my behaviour patterns. I was like, oh yeah, by the way, I used to have this issue

with eating and she's like, well, you had anorexia. I'm like, oh, that's a thing. Oh, you had bulimia. I knew I struggled with something. I just didn't know what it was. There wasn't a terminology then. And now that I understand it, I have so much grace and mercy for myself and I can understand it and identify it with young females that come in when they have root cause issues and it's going back to what is the root cause and why is it happening for them to come back to the true and authentic self. Dr. Amaro, just briefly, if you can, there are things that people can do if they can't fast aren't there? Tell me about that.

So just quickly to mention as well, your intention should always be about fasting for the right reasons. So if it is about anything to do with weight, shape or size or losing weight, don't, you know, you need to go and get help there and fix that. So yeah, the way that, sorry, could you? I was just talking about things that other things that you could do if you're not able to find. Sorry, fasting brain, it just flew out my head. Yeah, so of course people could engage in like dhikr, which is like a different form of worship.

So go to join the mosque, join women's groups, listen to podcasts, do anything creative, anything in line with their faith that helps them feel they're practicing in other ways, getting involved in charity, community work, if they're comfortable in being involved in the Iftar meals and preparing, being around family in general. There's so many different forms of worship and the main thing is they're exempt and God is merciful so it's not like they're going to be

punished or they're doing something wrong. Yeah. Thank you so much Dr. Amara and Nazia, thank you. And just once again there are links to support on the BBC Action Line website if anything we have been talking about has affected you. Thank you so much for coming in. Thank you. We've been asking for your stories about having to wing it when people assumed that you could do something. I said that I had to, I basically concealed that I couldn't ride a bike for many many years. This message here from Nicola. Nicola says, on a first date I insinuated I could ski thinking I wouldn't see this

man again. We ended up getting engaged and one of our first holidays together meeting his parents was a ski trip. I carried on the scenario that I could ski, purchased a fab outfit, he bought me skis and boots. He said let's do a blue blue run. I said, yes. Thinking, how hard can it be? I managed with a chairlift, but when we got off, I literally froze. He then clicked that I couldn't ski. I had to scoot shamefully on my bottom down the mountain and have never lived it down to this day. Nicola, thanks so much for getting in in touch. I've had humiliating times on a ski slope too because I can't ski either. Let's go to our next guest now, journalist and broadcaster

Julia Aside. She has published her debut novel, Don't Make Me Laugh, set in the world of stand-up comedy, a sphere often dominated by men. It's described as blackly comic, examining control, misogyny and the dark side of making people laugh. But it also celebrates women who speak out, find solidarity with each other, and then decide to fight back. And I'm delighted to say Julia is here with me in the Women's Hour Studio. Thanks for coming in, Julia.

Thank you for having me. Good morning. Why did you choose, then, to focus on the world of comedy for your first book? I suppose, I mean, I come from the point of view of being a fan. Comedy was always my thing, the thing I loved. The kind of the celebrities I looked up to were funny, even if they weren't comedians, if they were funny pop star or a funny actor, that would be the thing I was drawn to, the kind of nimble brain and the, you know, the idea of stand-up comedy

in particular always seemed a bit of a magic trick to me. Like, I could never imagine. I can just about talk on radio, but I could never imagine being in a room full of strangers standing at the head of that room and then just saying, find me funny. It just seems to me like psychologically such a baffling thing to want to do. So I think, yeah, for all those reasons, I think it looks like magic. I think I still think that. Yeah. You said that the comedy scene, this is a quote from something you wrote, for all those reasons. I think it looks like magic. I think I still think that. You said that the comedy scene, this is a quote from something you wrote, the comedy scene is stuffed with toxic men. So I wrote a novel about them. I mean,

that does seem a little sweeping considering your husband, I believe, is a comedy writer too. He is. You've got to love the headline writers. they always go right for the main vein. But yeah, I mean, this just comes from anecdotal experience. So I describe myself as comedy adjacent now. Obviously, I married into sort of the comedy world slightly with him. He writes, he doesn't perform. And we met, you know, I met lots of people through him who work in comedy, and particularly live comedy. And I think around, around maybe 2017, the Me Too movement beginning,

it seemed to loosen tongues a bit and women started to be more open about what their experiences are like working in this industry and the people like the women I knew who worked in live comedy just had these absolute horror stories and my jaw was sort of on the floor collectively over time. And then by the time I started writing this book in 2019, I just, you know, I just heard so many stories and I couldn't believe it was like an accepted part of their working life that they go to work. There's no kind of HR department

where they can take these problems to. And promoters, you know, the story, they're all anecdotes obviously, but the stories were of promoters asking for sexual favors in return for another gig. Stand up comedians who'd say, hey, sleep on my sofa or let me give you a lift back after an eight gig, sexually assaulting them, and just these were quite normal experiences. And so I think, I did try to write about them as a journalist, but legally that's quite tricky, as you can imagine. So I think the idea for the book just started to come from all of those stories, because I wanted to

have the conversation. Something I love, comedy is something I still love, but I couldn't believe this hidden side of it that was just an accepted part of these women's working lives. And you mentioned the existence of a list, a list where men in stand-up whose behaviour has been flagged by female female comedians and women working in the industry. Is that something that exists? Oh, yes, and I don't think one, I mean, I think the myth is that there are, you know, women in comedy, in quotes, are this sort of big collective who all communicate with each other, but pockets of women do communicate with each other not just stand-ups agents but women who

work in comedy either have whatsapp groups at one point I heard there was a Google Doc maybe more than one and and they update these with their stories of well actually this guy did something horrible to me in the wings of a comedy club or this guy I woke up with him on top of me when I stayed at his flat on his sofa. It's a vital resource that they provide for each other and again that in any other industry there would be uproar, there would be an HR reckoning and but they don't have HR in comedy, they just have each other. It's absolutely shocking that that might exist. Yeah. Let's talk about the novel itself, your main character is Ali, she's a radio producer. Is there a bit of the kind of Bridget Jones about her? Yeah, people have said that. I suppose I'm

soaked in that, you know, kind of in terms of the books I've read and I loved Bridget Jones and I've just been to see the new film and love that too. But I think the character I wrote, I mean she's coming up to 40, we meet her on her 40th birthday and I just, I needed her in terms of the character I wrote, I mean she's coming up to 40, we meet her on her 40th birthday and I just I needed her in terms of the story I knew I was going to write to be someone who was, I don't know, feeling like she was isolated, she works a very early, like the early breakfast show, so she's up before everyone else is up and she goes home as everyone else is arriving for work. So I just like the idea of her being quite isolated and radio, she was again comedy adjacent so she sort of would come up against this world and sort of start to see behind the curtain a bit. It just sort of worked for me that she was in

that kind of environment, sort of aware of showbiz but perhaps naive to this particular thing. to this, this particular thing. Yeah. Ed Katchapals, the central male comic, who I guess you would say that Ali is in a relationship with of sorts. Yes. Can you tell us about him? Yeah, so I think he initially, and this is something that I mean definitely comes from the stories I've been told, he presents as this, you know, almost a kind of rom-com, not an anti-hero, but like a rom-com. The guy that the girl ends up with when the handsome banker turns out to not be the guy she should be with, he's the funny, slightly shambolic, sort of slightly messy, emotionally man who makes her laugh and charms her and she kind of falls for his act basically, his skills and the skills, the thing I was interested in, the skills that some men have honed so

brilliantly in a room full of strangers, how to control that room, bring them up, bring them down again. They transfer them then to controlling women because they don't really want necessarily, there's this rock and roll idea that you know men in showbiz just want to have lots of sex with fans and some Of them do but the people I was interested in and what I think Ed Katchapall represents is the men who? It's they don't need sex. They need control. I think when we hit stories stories like Louis CK which he's just his his comeback tour has been selling out and he's coming back to the UK. And the story about him was that he masturbated

in front of women who thought they were going to meet him about work. And it's a really specific behavior that's not about having sex or having an untamed libido, which meant he couldn't stop himself. It's about wanting to be in a situation with women who aren't expecting you to do the thing you're about to do and to witness their kind of confusion panic how they go into

survival mode that's not about sex it's about control and that's what I was really interested in. We're gonna hear a bit from you of the novel and this is where Ali has gone to see Ed perform if you'd like to read that for us. Yeah so she's just met him and this is her kind of being taken behind the curtain I suppose of a comedy club. He put a hand on her back and leaned in to whisper, what I do on telly isn't really what I do live, this is me in a room. She felt electric moths down her back then he brushed past her and took the mic from Caroline as the applause broke Ali's stupor. The room warmed to him quickly beyond the black drapes. Ali clutched her

beer and craned to see through the gap to the small stage. Ed stood in front of the mic, sorry, Ed stood in front of the mic stand, one hand behind draped over the top of it like it was a perch designed specifically for the purpose. If she passed Ed in the street, maybe she wouldn't notice him. His clothes hung oddly and his dehydrated skin was multicoloured in the harsh stage light. The pocket of stubbly flesh under his chin wobbled when he became emphatic. In a Hollywood film he'd play the basement dweller brought in to hack the mainframe, not the lead man, not even the best friend, but up there looking down from his pulpit. He was their leader. It's like the pedals on a piano. He'd lean towards Ali in the

pub before the show, about to impart classified information. He was nudging at the border of real pretension, and Ali couldn't help drinking it in, feeling the glow of privilege at being invited behind the curtain. She folded her crisp bag into a triangle while she listened, trying to seem less sycophantic. Yeah, piano pedals, loud, quiet, loud again. You work out a rhythm that's pleasing and it almost doesn't matter what you're saying. Watching now through the gap in the drapes, Ali couldn't drag her eyes away but she wasn't looking at Ed anymore. It was them. A sliver of the audience, faces turned towards him, eyes screwed, skin

around their mouths creasing. He'd got them where he wanted them. It's very compelling. It was a very interesting book to read. Ed Catchpole was extremely believable. You've been asked a lot who he's based on. Is he based on anyone? I can finally reveal no. I think as mentioned, I've heard so many stories and I think the idea that I'd even pick one person and kind of subtly try and lead the reader to him, it sort of defeats the object because unfortunately I'm writing about something that is not even like a few bad men. It's an industry steeped in misogyny. It's changing like in front of the curtain. It's full of women and non-binary people and people doing incredible stuff.

And it looks much more equal from the front of house where I sit and watch it. But behind the scenes, it's still kind of a boys' club. And yeah, that's kind of what I was wanting to root out, hopefully with humor. Ironically for a book called Don't Make Me Laugh, I have tried to make the reader laugh, because I don't think the subject matter gets over

as well if I'm just, I mean I'm really angry about it. Something I love is being spoiled and yeah, so I wanted to convey the anger in a witty way, hopefully. Yeah. Which I should also point out there's a lot about female friendship in there as well. Yes. It's been so lovely to speak to you. Julia Rayside, thank you for coming into Women's Hour today. Thank you.

And that is it on the programme for today. Just to let you know that on tomorrow's Women's Hour, Nula will be speaking to Grammy award-winning Lainey Wilson, a country music trailblazer. She's gone from Hannah Montana impersonator to performing at the Grand Old Opry and she'll discuss her new album, Whirlwind and headlining at the C2C Festival at London's O2 this weekend. Thank you for listening. That's all for today's Woman's Hour. Join us again next time.

A new podcast series from BBC Radio 4. In the first stage of a poltergeist haunting, the entity will confine itself to making noise as if it's testing its victims the Battersea poltergeist my name is Shirley Hitchens I'm 15 years old I live with my mom dad brother gran and Donald subscribe to the Battersea poltergeist on BBC Sounds. Saturn! That was very well done that because in the script it does say wrestling voice. After all of that it's going to kind of chill out a bit and talk about ice. And also in this series we're discussing history of music, recording with Brian Eno, and looking at nature's shapes.

So listen wherever you get your podcasts.